These results suggest that Temodal has activity against newly diagnosed GBM and AA and warrants continued evaluation of this agent. Furthermore, pretherapy analysis of tumor DNA mismatch repair and, particularly, AGT protein expression may identify patients in whom tumors are resistant to Temodal.

The MTD for administration of 131I-labeled 81C6 into the SCRCs of previously irradiated patients with recurrent primary or metastatic brain tumors was 100 mCi. The dose-limiting toxicity was neurologic toxicity. We are encouraged by the minimal toxicity and survival in this phase I trial. Radiolabeled mAbs may improve the current therapy for brain tumor patients.

No abstract

A CNS infection due to cytomega lovirus (CMV) is typically seenin individualswith AIDS and is un common in individuals who are immunosup pressed for other reasons. In general, brain infection by CMV is more common than spinal infection, and the latter is usually manifested by spinal nerve root involvement (i.e., polyradicu litis) [1]. We report the MR imaging findings in an immunosuppressed patient without AIDS in whom clinical and imaging findings were located predominantly in the spinal cord rather than in the brain or spinal nerve roots.The imaging findings of CMV encephalo myelitis are important to recognize because early specific therapy may be life-saving. Case ReportA left breastmasswasfoundat mammogra phy in a 51-year-old woman and was diag nosed as carcinoma by needle biopsy. She underwent left mastectomy and axillary node dissection, which showed multiple lymph nodes positive for the presence of carcinoma. She was treated with a regimen of cyclophos phamide,methotrexate,and 5-fluorouracil. Six years later she developed a left chest wall mass. Fine-needle biopsy showed metastatic breast carcinoma, and she was treated with doxorubicin for 3 months, with a marked de crease in the size of the mass, followed by treatment with cisplatin, carmustine, and cy clophosphamide with stem-cell rescue. Two weeks after completion of chemotherapy, she began to experience leg paresthesias that were initially thought to represent effects of chemo therapy. The paresthesias slowly progressed over the next 6 weeks, consistent with cisplatin sensory polyneuropathy. However, over the course of 1 week, rapidly progressive leg anes thesia, paraparesis,and urinary incontinence developed.Lumbar punctureand MR imaging findings of the brain and total spine 2 days af ter rapid onset of clinical deterioration were negative. The patient was then transferred to our institution for further examination.A secondMR imaging study on hospital day I (7 days after the initial MR imaging study) revealed multiple sites of hyperintense signal on T2-weighted images involving the cervical spinal cord and medulla (Fig. lÀ).On unenhanced TI-weighted images, the lesions appeared hypointense. After contrast adminis tration, the cervical spine lesions showed ring like enhancement,whereas those within the medulla showed nodular enhancement (Fig. lB). MR imaging of the brain did not reveal other lesions. Because of the possibility that the lesionsrepresentedintramedullary metastases, 18F-fluorodeoxyglucose positron emission to mography was performed on hospital day 8. No increasedmetabolic activity was seenwithin the lesions, and this finding was inter preted as evidence against metastasis. On the assumptionthat the myelopathy could be due to an inflammatoiy demyelinating process, corticosteroid therapy was started on hospital day 3. Follow-up MR imaging on hospital day 9 showed an increase in the size and contrast enhancement of the lesion. A sample of CSF from a secondlumbar punctureon hospital day 13 had positive findings for CMV as deter mined by p...

A ccurate evaluation of the intracere bral vasculature is essential to the proper diagnosis and treatment of many neurologic disorders, including athero matous cerebrovascular disease, aneurysms, and arteriovenous malformations (AVMs). Catheter angiography has been the traditional gold standard for accurate depiction of intrace rebral vessels but is invasive and associated with a small (but significant) risk of cornplica tion, including an approximately 1% risk of permanent neurologic deficit I I 1. MR arteriography is a fast, noninvasivetechnique that does not require the use of ex ogenous contrast material yet provides an an atomic depiction of the intracerebral arteries.Further. in those types of MR arteriography in which source images are provided, inter active examination of these images may re duce problems with overlapping vessels that may be encountered in catheter angiography. The purposes of this essay are to review the anatomy of the intracranial vasculature as seen on intracranial MR arteriography and to summarize its current applications.Although many potential applications of in tracranial MR arteriography have been re ported, the clinical usefulness of the procedure remains poorly studied. One problem in as sessing the usefulness of intracranial MR arte riography is that the implementation of the technique varies widely from institution to insti tution. Most commonly, intracranialMR arteri ography is performed using either time-of-flight (TOF) or phase-contrast techniques. In TOF imaging, vessels are detected because of the inflow of unsaturated spins into the imaging plane. In phase-contrast imaging, vessels are detected because moving protons within yes sels accumulate phase shifts proportional to their velocity as they cross a magnetic gradi ent. Both of these techniques can be performed in either two-dimensional or three-dimen sional (3D) acquisitions. Differences in MR hardware, pulse sequences used, and data pre sentation (an often overlooked factor) affect the clinical usefulness of the procedure. Anatomy and Normal VariantsThe circle of Willis, in its classic form, is a nine-sided anastomotic network connecting the anterior circulation (derived from the internal carotid arteries) and the posterior circulation (derived from the yertebralâ€"ba.silar system). As such, the circle of Willis is a major source of collateral circulation to the brain when severe stenosis or occlusion of the internal carotid or basilar arteries occurs. T.e anterior portion of the circle consists of a portion of both internal carotid arteries; the paired proximal horizontal portions of the anterior cerebral arteries (Al segments); and the anterior communicating ar tery. The posterior portion of the circle consists of the proximal portions of both posterior cere bral arteries (P1 segments) and the bilateral pos terior communicating arteries (Fig. I).The anatomic description outlined pertains to the classic form of the circle of Willis, in which each segment is symmetric and well de Other variantsof the circle of Willi...